This randomized phase III trial studies enzalutamide to see how well it works compared to enzalutamide, abiraterone, and prednisone in treating patients with castration-resistant metastatic prostate cancer. Androgens can cause the growth of prostate cancer cells. Drugs, such as enzalutamide, abiraterone acetate, and prednisone, may lessen the amount of androgens made by the body.
Patients are randomized to one of two treatment groups: enzalutamide or enzalutamide, abiraterone and prednisone. Treatment will continue until disease progression or unacceptable toxicity. Patients are followed for clinical outcomes for a maximum of 5 years post study treatment. The primary and secondary objectives are described below. 1. Primary Objective: To compare the overall survival of patients with progressive metastatic castration-resistant prostate cancer (CRPC) treated with either enzalutamide only or enzalutamide with abiraterone and prednisone 2. Secondary Objectives: * To assess the grade 3 or higher toxicity profile and compare safety by treatment arm. * To assess and compare post-treatment prostate-specific antigen (PSA) declines by treatment arm. * To compare radiographic progression free survival defined by Prostate Cancer Working Group 2 (PCWG2), and objective response rate, by treatment arm. * To test for radiographic progression free survival (rPFS) treatment interaction in predicting overall survival. * To assess pre- and post-treatment measures of tumor burden and bone activity using sodium fluoride (NaF) positron emission tomography (PET)/computed tomography (CT) and technetium (Tc) methylene diphosphonate (MDP) bone scintigraphy and correlate these measures with overall survival. * To develop and validate prognostic and predictive models of overall survival that include baseline clinical and molecular markers.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
1,311
Enzalutamide 160 mg daily, orally
abiraterone 1000 mg daily, orally
prednisone 5 mg twice daily, orally
University of Alabama at Birmingham Cancer Center
Birmingham, Alabama, United States
Southern Cancer Center PC-Providence
Mobile, Alabama, United States
Katmai Oncology Group
Anchorage, Alaska, United States
Providence Alaska Medical Center
Anchorage, Alaska, United States
Mayo Clinic in Arizona
Scottsdale, Arizona, United States
Overall Survival (OS)
Overall survival is defined as the time from study registration to death due to any cause.
Time frame: Up to 5 years post treatment
Number of Participants Who Has Experienced at Least One Toxicity (Defined as a Grade 3 or Higher Adverse Event Deemed at Least Possibly Related to Treatment)
The number of participants who has experienced at least one toxicity (defined as a grade 3 or higher adverse event deemed at least possibly related to treatment)
Time frame: Up to 5 years post treatment
Decline in Prostate Specific Antigen (PSA)
Time frame: Up to 5 years post treatment
Progression Free Survival (PFS)
Time frame: Up to 5 years post treatment
Objective Response Rate
Time frame: Up to 5 years post treatment
Radiographic Progression Free Survival (rPFS)
Time frame: Up to 5 years post treatment
Tumor Burden and Bone Activity
Time frame: Up to 5 years post treatment
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University of Arizona Cancer Center-Orange Grove Campus
Tucson, Arizona, United States
University of Arizona Cancer Center-North Campus
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The University of Arizona Medical Center-University Campus
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